P_RM_06 Serious Untoward Incident Policy

A serious incident is defined by the National Patient Safety Agency as:

  • Unexpected or avoidable death of one or more patients, staff, visitors or members of the public;
  • Serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention, major surgical/medical intervention, permanent harm, or will shorten life expectancy, or result in prolonged pain or psychological harm (this includes incidents graded under the NPSA definition of severe harm);
  • A scenario that prevents or threatens to prevent a provider organisation's ability to continue to deliver health care services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment, or IT failure;
  • Allegations of abuse;
  • Adverse media coverage or public concern for the organisation or the wider NHS;
  • One of the core set of "Never Events" as updated on an annual basis

Promoting patient safety by reducing errors is a key priority for the NHS. This responsibility is highlighted by Department of Health guidance, Organisation with a Memory (DOH 2000) and Building a Safer NHS (DOH 2001) which, collectively, emphasise the need to learn from adverse events. The Organisation must ensure that Serious Incidents (SIs) are identified, reported and managed in an effective and timely way.

Key words from policy:

Emergency planning, Major incidents, serious incidents, mortality, never events, professional misconduct, terrorism, chemical, biological, radiological or nuclear incidents, unexpected death, serious harm or injury, safeguarding children and vulnerable adults, loss of confidential information, serious adverse drug reactions, legal incidents, litigation, substance misuse, violence towards health care staff, risk evaluation, risk register, root cause analysis, practitioner performance, inquest.


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